Written up and confused. - page 3

by pageturnstyle 11,507 Views | 55 Comments

I have been a nurse for 2 years now and have been fortunate enough to avoid any deaths on my shift until recently. Last week I had a hospice patient with a DNR who was exhibiting Cheyne-Stokes breathing, fixed pupils, and a thick... Read More


  1. 2
    Your NM could also be "one of those". The type of nurse that believes all hospice patients need to just die and the faster the better. Choking/drowning is fine to them whether on food or bile or blood or what I call lung water. Some of this type actually believe that you are making them live longer if you try to give comfort care. To these nurses, you either let the person die naturally by any means (hands off, except for changing briefs) or you just load that syringe and push fast.
    joanna73 and lindarn like this.
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    You did not do anything wrong! This is total BS. When a pt is a DNR you are still supposed to make them comfortable. You were looking out for your patients best interest. You need to go above your supervisor on this one.
    lindarn likes this.
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    She also said she would do an inservice for the unit managers to help prevent intimidation and other inappropriate behavior in the future.
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    Well done. It's hard to be courageous. Great job!
    SHGR, CNAtoCRNA, cienurse, and 3 others like this.
  4. 6
    My heart goes out to you! I have been in your shoes and in the real "nursing world" please be extremely careful when you venture in
    following the so-called "chain of command" path. I got terminated for doing the "right" thing and at times Administrators are in a fantasy world and don't want any employee rocking the boat! If you are seeing " red" flags that managers are piling up derogatory
    reports, you need to have an escape plan and look for employment elsewhere as the integrity of the manager is questionable and you are in a very hostile working environment. If you don't have strong alliances at the top , you are putting your nursing career on the line
    It caused me dearly and my 25 yrs impeccable nursing career got ruined because of senseless and malicious gossips !!!
    I fought hard because of good principle but unfortunately , I was dealing with different caliber of people .... Take care and good luck!

    P.S. If managers are issuing Corrective Actions ... make sure you write a rebuttal on the C.A. Statement. Unfortunately, the prevailing rule per institutional policy = refusal to sign is automatic termination on the spot unless you file a grievance with HR and again make sure you have a strong basis to support a claim and always have a witness during any disciplinary proceedings and make anecdotal notes in your memory bank of issues that might back fire.
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    I mean, you could have just as soon reached in and scooped it out with a swab or toothbrush. You don't need a doctor's order to perform oral care do you? But how gross and undignified is that? And what if something had droped back into her throat as you did that? THAT would've killed her. So, I'm sure the suction was quick, clean, and safer. The removal of the pocketed food was appropriate, regardless of what tool you used. I think you demonstrated a decent amount of critical thinking and problem-solving. Especially since it would have just rotted in her mouth (also undignified) and the family would have to be in there sitting with the stench (also undignified and obstructive to their grieving process). Don't let her do this to you.
    TeenyTinyBabyRN, cienurse, TJ'sMOM, and 3 others like this.
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    You know you did the right thing. Comfort care and DNR's don't equal no treatment. You did not un-necessarily prolong the patient's suffering, nor did you do anything that would be out of the norm of comfort care. A yankaur suction to the mouth is definetely not something that needs an order in most facilities. You were not deep suctioning the patient--and even then, sometimes that is needed to alleviate the patient's distress that no amount of morphine could help. I wonder what the family would have said if said patient choked on the pocketed food, started flailing and gagging.....that would have been a heartbreaking scene and completely uncalled for.

    Apparently your NM needs the education on how to conduct herself appropriately. Hopefully, she will take it to heart.
    Wise Woman RN and lindarn like this.
  7. 0
    I have had to suction w/o an order before in emergency situations. If there was no order, I called after to update the doc and get the order. What did she want? Let the pt cont regurgitating/choking on food while you called the doc?
  8. 1
    I agree that you acted with the intent of providing comfort for the patient who was in the process of actively dying.

    There was no way this poor individual was going to swallow the food pocketed in her mouth. At best it was going to sit there, rot, and smell bad. At worst it was going to actively choke her and cause an uncomfortable death.

    If you had an active medical order on the chart, which had not been discontinued by hospice, to suction as needed I believe you are covered.

    It sounds as if, perhaps, hospice had a conversation with your manager about how much the family appreciated your efforts. You acted like a nurse who could provide good compassionate care for a dying patient again.
    TJ'sMOM likes this.
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    I think you should consult a lawyer and if you are a member of a nurse's union consult with them also. I think that you are just doing your duty and what you believe is best for the patient.
    jrwest likes this.
  10. 3
    Wow. In my 23 years of experience, I've never heard of having to have an order to orally suction a patient in this manner. We suction our hospice patients, and hospice actually set up a portable suction machine at my house when my son was dying. To not do so is simply inhumane. Your manager needs to educate herself.


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